Common use of Daily Cost Sharing Clause in Contracts

Daily Cost Sharing. Daily Cost Sharing reduces the patient pay for the prescription that is less than the standard defined days’ supply. Exclusions may include drug products for acute therapy, unbreakable packages and controlled substances. This benefit has one or more exclusions as specified in the Exclusions Section. You have the option to purchase up to a 90-day supply of Prescription Drugs/Medications. Under the up to a 90-day at Retail Pharmacy benefit, Preferred Generic, Non-Preferred Generic, Preferred Brand and Non-Preferred Drugs can be obtained from an In-network Pharmacy. If you chose the 90 days at retail option, you will be charged on copayment per 30-day supply up to a maximum of a 90-day supply. Some medications may qualify for third-party copayment assistance programs which could lower your out-of-pocket costs for those products. For any such medication where third-party copayment assistance is used (Discount Cards or Prescription Drug Savings Cards), the Member shall not receive credit toward their maximum out-of-pocket or deductible for any copayment or coinsurance amounts that are applied to a manufacturer coupon or rebate. Self-Administered Specialty Pharmaceuticals are self-administered, meaning they are administered by the patient, a family member or care-giver. Specialty Pharmaceuticals are often used to treat complex chronic, rare diseases and/or life- threatening conditions. Specialty Pharmaceuticals are often high cost, typically greater than $600 for up to a 30-day supply. • Specialty Pharmaceuticals are not available through the retail or mail order option and are limited to a 30-day supply. • Certain Specialty Pharmaceuticals may have additional day supply limitations. • Most Specialty Pharmaceuticals require Prior Authorization and must be obtained through the specialty pharmacy network. • Most Specialty Pharmaceuticals must be obtained through the specialty pharmacy network. For a complete list of these drugs, please see the Specialty Pharmaceutical listing at xxxx://xxxx.xxx.xxx/idc/groups/public/documents/communication/pel_00236101.pdf. For Specialty Pharmacy information please see the pharmacy services available at xxxxx://xxx.xxx.xxx/doctors-services/services-centers/supporting- services/Pages/pharmacy-services.aspx. You can call our Presbyterian Customer Service Center for additional information about the Presbyterian Specialty Pharmacy network, Monday through Friday from 7 a.m. to 6 p.m. at (000) 000-0000 or 1-800- 356-2219. Hearing impaired users may call TTY 711.

Daily Cost Sharing. Daily Cost Sharing reduces the patient pay for the prescription that is less than the standard defined days’ supply. Exclusions may include drug products for acute therapy, unbreakable packages and controlled substances. Benefit Limitations This benefit has one or more exclusions as specified in the Exclusions Section. You have the option to purchase up to a 90-day supply of Prescription Drugs/Medications. Under the up to a 90-day at Retail Pharmacy benefit, Preferred Generic, Non-Preferred Generic, Preferred Brand and Non-Preferred Drugs can be obtained from an In-network Pharmacy. If you chose the 90 days at retail option, you will be charged on copayment per 30-day supply up to a maximum of a 90-day supply. Some medications may qualify for third-party copayment assistance programs which could lower your out-of-pocket costs for those products. For any such medication where third-party copayment assistance is used (Discount Cards or Prescription Drug Savings Cards), the Member shall not receive credit toward their maximum out-of-pocket or deductible for any copayment or coinsurance amounts that are applied to a manufacturer coupon or rebate. Self-Administered Specialty Pharmaceuticals are self-administered, meaning they are administered by the patient, a family member or care-givercaregiver. Specialty Pharmaceuticals are often used to treat complex chronic, rare diseases and/or life- threatening conditions. Specialty Pharmaceuticals are often high costcosts, typically greater than $600 for up to a 30-day supply. • Specialty Pharmaceuticals are not available through the retail or mail order option and are limited to a 30-day supply. • Certain Specialty Pharmaceuticals may have additional day supply limitations. • Most Specialty Pharmaceuticals require Prior Authorization and must be obtained through the specialty pharmacy network. • Most Specialty Pharmaceuticals must be obtained through the specialty pharmacy Pharmaceutical network. For a complete list of these drugs, please see the Specialty Pharmaceutical listing at xxxx://xxxx.xxx.xxx/idc/groups/public/documents/communication/pel_00236101.pdf. For Specialty Pharmacy information please see the pharmacy services available at xxxxx://xxx.xxx.xxx/doctors-services/services-centers/supporting- services/Pages/pharmacy-services.aspxxxxx://xxxx.xxx.xxx/idc/groups/public/documents/communication/pel_00000000.pdf. You can call our Presbyterian Customer Service Center for additional information about the Presbyterian Specialty Pharmacy networkCenter, Monday through Friday Friday, from 7 a.m. to 6 p.m. at (000) 000-0000 or 10-800- 356000-2219000-0000. Hearing impaired users may call TTY 711.

Daily Cost Sharing. Daily Cost Sharing reduces the patient pay for the prescription that is less than the standard defined days’ supply. Exclusions may include drug products for acute therapy, unbreakable packages and controlled substances. This benefit has one or more exclusions as specified in the Exclusions Section. You have the option to purchase up to a 90-day supply of Prescription Drugs/Medications. Under the up to a 90-day at Retail Pharmacy benefit, Preferred Generic, Non-Preferred Generic, Preferred Brand and Non-Preferred Drugs can be obtained from an In-network Pharmacy. If you chose the 90 days at retail option, you will be charged on copayment per 30-day supply up to a maximum of a 90-day supply. Some medications may qualify for third-party copayment assistance programs which could lower your out-of-pocket costs for those products. For any such medication where third-party copayment assistance is used (Discount Cards or Prescription Drug Savings Cards), the Member shall not receive credit toward their maximum out-of-pocket or deductible for any copayment or coinsurance amounts that are applied to a manufacturer coupon or rebate. Self-Administered Specialty Pharmaceuticals are self-administered, meaning they are administered by the patient, a family member or care-givercaregiver. Specialty Pharmaceuticals are often used to treat complex chronic, rare diseases and/or life- threatening conditions. Most Specialty Pharmaceuticals require Prior Authorization and must be obtained through the specialty pharmacy network. Specialty Pharmaceuticals are often high cost, typically greater than $600 for up to a 30-day supply. • · Specialty Pharmaceuticals are not available through the retail or mail order option and are limited to a 30-day supply. • Certain Specialty Pharmaceuticals may have additional day supply limitations. • Most Specialty Pharmaceuticals require Prior Authorization and must be obtained through the specialty pharmacy network. • · Most Specialty Pharmaceuticals must be obtained through the specialty pharmacy Specialty Pharmaceutical network. For a complete list of these drugs, please see the Specialty Pharmaceutical listing at xxxx://xxxx.xxx.xxx/idc/groups/public/documents/communication/pel_00236101.pdf. For Specialty Pharmacy information please see the pharmacy services available at xxxxx://xxx.xxx.xxx/doctors-services/services-centers/supporting- services/Pages/pharmacy-services.aspxxxxx://xxxx.xxx.xxx/idc/groups/public/documents/communication/pel_00000000.pdf. You can call our Presbyterian Customer Service Center for additional information about the Presbyterian Specialty Pharmacy networkCenter, Monday through Friday Friday, from 7 a.m. to 6 p.m. at (000) 000-0000 or 10-800- 356000-2219000-0000. Hearing impaired users may call TTY 711.

Daily Cost Sharing. Daily Cost Sharing reduces the patient pay for the prescription that is less than the standard defined days’ supply. Exclusions may include drug products for acute therapy, unbreakable packages and controlled substances. This benefit has one or more exclusions as specified in the Exclusions Section. You have the option to purchase up to a 90-day supply of Prescription Drugs/Medications. Under the up to a 90-day at Retail Pharmacy benefit, Preferred Generic, Non-Preferred Generic, Preferred Brand and Non-Preferred Drugs can be obtained from an In-network Pharmacy. If you chose the 90 days at retail option, you will be charged on copayment per 30-day supply up to a maximum of a 90-day supply. Some medications may qualify for third-party copayment assistance programs which could lower your out-of-pocket costs for those products. For any such medication where third-party copayment assistance is used (Discount Cards or Prescription Drug Savings Cards), the Member shall not receive credit toward their maximum out-of-pocket or deductible for any copayment or coinsurance amounts that are applied to a manufacturer coupon or rebate. Self-Administered Specialty Pharmaceuticals are self-administered, meaning they are administered by the patient, a family member or care-givercaregiver. Specialty Pharmaceuticals are often used to treat complex chronic, rare diseases and/or life- threatening conditions. Most Specialty Pharmaceuticals require Prior Authorization and must be obtained through the specialty pharmacy network. Specialty Pharmaceuticals are often high cost, typically greater than $600 for up to a 30-day supply. • Specialty Pharmaceuticals are not available through the retail or mail order option and are limited to a 30-day supply. • Certain Specialty Pharmaceuticals may have additional day supply limitations. • Most Specialty Pharmaceuticals require Prior Authorization and must be obtained through the specialty pharmacy network. • Most Specialty Pharmaceuticals must be obtained through the specialty pharmacy Pharmaceutical network. For a complete list of these drugs, please see the Specialty Pharmaceutical listing at xxxx://xxxx.xxx.xxx/idc/groups/public/documents/communication/pel_00236101.pdf. For Specialty Pharmacy information please see the pharmacy services available at xxxxx://xxx.xxx.xxx/doctors-services/services-centers/supporting- services/Pages/pharmacy-services.aspx. You can call our Presbyterian Customer Service Center for additional information about the Presbyterian Specialty Pharmacy networkCenter, Monday through Friday Friday, from 7 a.m. to 6 p.m. at (000) 000-0000 or 10-800- 356000-2219000-0000. Hearing impaired users may call TTY 711.